Healthcare Provider Details

I. General information

NPI: 1477663359
Provider Name (Legal Business Name): CHLOE MAE STRAW MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHLOE MAE RICHARDS MSPT

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 CONSTITUTION AVE REHABILITATION TODAY
OLEAN NY
14760
US

IV. Provider business mailing address

2416 CONSTITUTION AVE REHABILITATION TODAY
OLEAN NY
14760
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-2808
  • Fax: 716-372-2902
Mailing address:
  • Phone: 716-372-2808
  • Fax: 716-372-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026545
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00262929
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMEDICARE RAILROAD
# 2
IdentifierB2598447
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: